Cynthia Miller, MD, MPH, FACP | Vice President, Medical Director, Access Experience
Barbara Henry, RPh | Vice President, Access Experience Team
Ensuring patients get the medications they need requires navigating a complex system. Pharmacists are at the center of this challenge, working behind the scenes to overcome barriers that most people never see. What’s really happening on the front lines of access and reimbursement, and how can manufacturers help turn obstacles into opportunities for better patient care?
Pharmacists are the linchpins of patient care, working diligently to ensure timely access to essential medications. Yet the journey is rarely straightforward. Across health systems, IDNs, or specialty pharmacies, pharmacists are increasingly consumed by the intricacies of payer coverage requirements, managing documentation, and keeping pace with evolving technologies.
Precision AQ recently conducted a series of five in-depth interviews with pharmacists, which reveal just how much the coverage landscape varies, and how challenging the prior authorization and coverage request processes can be to navigate.
Smaller health systems and pharmacies often operate with limited staff, resulting in increased manual work and fragmented workflows. Larger organizations may have dedicated teams and better EMR integration, but they still grapple with complexity as payer requirements and state regulations constantly shift. Although every organization faces its own set of challenges, common themes are evident across the industry.
Payer policies remain a significant source of frustration. Unclear documentation requirements, network lockouts, and site-of-care restrictions frequently delay patient access. Even as most prior authorization (PA) requests are now submitted electronically, manual steps are still common, especially in office workflows. Widely used platforms like CoverMyMeds help, but integration and standardization challenges persist.
Meanwhile, the volume of PA requests continues to rise, outpacing available administrative and clinical support. Untrained staff and automated decisions without clinical oversight can lead to errors and inappropriate denials, adding to pharmacists' burden.
Pharmacists are nothing if not resourceful. Many rely on a mix of in-house developed tools, vendor solutions, and manufacturer-provided materials. Still, manufacturer assistance often falls short of meeting pharmacists' actual needs.
Resources can be hard to find, not tailored to specific needs, or simply unavailable when needed most. As a result, pharmacists often create their own templates and checklists to fill the gaps, especially for letters of medical necessity or appeals.
Digital tools and electronic PA systems have made some processes more efficient, but they haven’t eliminated manual work. Integration with EMRs is often incomplete, and security concerns or a lack of standardization can hinder seamless workflows. The result is a patchwork system where pharmacists must constantly adapt and troubleshoot.
There’s also a growing interest in using AI to streamline workflows, automate documentation, and support real-time decision-making. However, adoption remains limited due to concerns about vendor sustainability, integration, and privacy. While the potential for AI-driven transformation is clear, most organizations are still in the early stages of exploration.
So, how can manufacturers and other stakeholders truly support pharmacists and improve patient access? The research points to several actionable strategies:
Recognize that every pharmacy and health system is different. Tiered support models that reflect the unique needs and capabilities of each organization are essential.
Partner with leading platforms and health systems to cut the friction out of the PA process and promote standardization.
Empower nonclinical staff with training and resources that reduce errors and boost efficiency.
Integrate AI into manufacturer services and support AI utilization in EMR with resources.
Offer dedicated field reimbursement managers real-time support. Ensure digital and product-specific resources are easy to find, without digging through emails or outdated portals.
Pharmacists are doing heroic work on the front lines of patient access, but they can’t do it alone. While progress has been made, significant barriers remain, and the stakes for patients and providers are high. Manufacturers have a unique opportunity to drive meaningful change by tailoring support, investing in digital and AI-powered solutions, advocating for standardization, and providing real-time resources and training.
This is where Precision AQ can help. With deep expertise in access and reimbursement strategy, actionable insights from real-world pharmacy leaders, and a commitment to partnership, Precision AQ is ready to help manufacturers break down barriers. Collaboration between manufacturers, pharmacists, payers, and technology partners is essential to streamline processes, reduce administrative burden, and ensure that patients receive the therapies they need—when they need them.
Ready to turn obstacles into opportunities? Precision AQ is here to help you empower pharmacists and improve patient access for all.